OT intramuscular needling

AN ACT Relating to occupational therapists performing 1
intramuscular needling; reenacting and amending RCW 18.59.020; and 2
adding a new section to chapter 18.59 RCW. 3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:4
Sec. 1. RCW 18.59.020 and 2011 c 88 s 1 are each reenacted and 5
amended to read as follows: 6
Unless the context clearly requires otherwise, the definitions in 7
this section apply throughout this chapter. 8
(1) "Board" means the board of occupational therapy practice.9
(2) "Department" means the department of health.10
(3) "Intramuscular needling," also known as "dry needling," means 11
a skilled intervention that uses a single use, sterile filiform 12
needle to penetrate the skin and stimulate underlying myofascial 13
trigger points and connective and muscular tissues for the evaluation 14
and management of neuromusculoskeletal pain and movement impairments. 15
"Intramuscular needling" requires an examination and diagnosis. 16
"Intramuscular needling" does not include needle retention without 17
stimulation or the stimulation of auricular and distal points.18
(4) "Occupational therapist" means a person licensed to practice 19
occupational therapy under this chapter. 20
H-2570.1
HOUSE BILL 2184
State of Washington 69th Legislature 2026 Regular Session
By Representatives Parshley, Engell, Reed, Duerr, Goodman, and Macri
Prefiled 12/22/25. Read first time 01/12/26. Referred to Committee
on Health Care & Wellness.
p. 1 HB 2184
(((4))) (5) "Occupational therapy" is the scientifically based 1
use of purposeful activity with individuals who are limited by 2
physical injury or illness, psychosocial dysfunction, developmental 3
or learning disabilities, or the aging process in order to maximize 4
independence, prevent disability, and maintain health. The practice 5
encompasses evaluation, treatment, and consultation. Specific 6
occupational therapy services include but are not limited to: Using 7
specifically designed activities and exercises to enhance 8
neurodevelopmental, cognitive, perceptual motor, sensory integrative, 9
and psychomotor functioning; administering and interpreting tests 10
such as manual muscle and sensory integration; teaching daily living 11
skills; developing prevocational skills and play and avocational 12
capabilities; designing, fabricating, or applying selected orthotic 13
and prosthetic devices or selected adaptive equipment; wound care 14
management as provided in RCW 18.59.170; performing intramuscular 15
needling; and adapting environments for persons with disabilities. 16
These services are provided individually, in groups, or through 17
social systems. 18
(((5))) (6) "Occupational therapy aide" means a person who is 19
trained to perform specific occupational therapy techniques under 20
professional supervision as defined by the board but who does not 21
perform activities that require advanced training in the sciences or 22
practices involved in the profession of occupational therapy.23
(((6))) (7) "Occupational therapy assistant" means a person 24
licensed to assist in the practice of occupational therapy under the 25
supervision or with the regular consultation of an occupational 26
therapist. 27
(((7))) (8) "Occupational therapy practitioner" means a person 28
who is credentialed as an occupational therapist or occupational 29
therapy assistant. 30
(((8))) (9) "Person" means any individual, partnership, 31
unincorporated organization, or corporate body, except that only an 32
individual may be licensed under this chapter. 33
(((9))) (10) "Secretary" means the secretary of health.34
(((10))) (11) "Sharp debridement" means the removal of loose or 35
loosely adherent devitalized tissue with the use of tweezers, 36
scissors, or scalpel, without any type of anesthesia other than 37
topical anesthetics. "Sharp debridement" does not mean surgical 38
debridement. 39
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(((11))) (12) "Wound care management" means a part of 1
occupational therapy treatment that facilitates healing, prevents 2
edema, infection, and excessive scar formation, and minimizes wound 3
complications. Treatment may include: Assessment of wound healing 4
status; patient education; selection and application of dressings; 5
cleansing of the wound and surrounding areas; application of topical 6
medications, as provided under RCW 18.59.160; use of physical agent 7
modalities; application of pressure garments and nonweight-bearing 8
orthotic devices, excluding high-temperature custom foot orthotics 9
made from a mold; sharp debridement of devitalized tissue; 10
debridement of devitalized tissue with other agents; and adapting 11
activities of daily living to promote independence during wound 12
healing. 13
NEW SECTION. Sec. 2. A new section is added to chapter 18.59 14
RCW to read as follows: 15
(1)(a) Subject to the limitations of this section, an 16
occupational therapist may perform intramuscular needling only after 17
being issued an intramuscular needling endorsement by the secretary. 18
The secretary, upon approval by the board, shall issue an endorsement 19
to an occupational therapist who has at least one year of 20
postgraduate practice experience that averages at least 36 hours a 21
week and consists of direct patient care and who provides evidence in 22
a manner acceptable to the board of a total of 325 hours of 23
instruction and clinical experience that meet or exceed the following 24
criteria: 25
(i) A total of 100 hours of didactic instruction in the following 26
areas: 27
(A) Anatomy and physiology of the musculoskeletal and 28
neuromuscular systems; 29
(B) Anatomical basis of pain mechanisms, chronic pain, and 30
referred pain; 31
(C) Trigger point evaluation and management; 32
(D) Universal precautions in avoiding contact with a patient's 33
bodily fluids; and 34
(E) Preparedness and response to unexpected events including, but 35
not limited to, injury to blood vessels, nerves, and organs, and 36
psychological effects or complications; 37
(ii) A total of 75 hours of in-person intramuscular needling 38
instruction in the following areas: 39
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(A) Intramuscular needling technique; 1
(B) Intramuscular needling indications and contraindications;2
(C) Documentation and informed consent for intramuscular 3
needling; 4
(D) Management of adverse effects; 5
(E) Practical psychomotor competency; and 6
(F) Occupational safety and health administration's bloodborne 7
pathogens protocol; 8
(iii) A successful clinical review of a minimum of 150 hours of 9
at least 150 individual intramuscular needling treatment sessions by 10
a qualified provider. An occupational therapist seeking endorsement 11
must submit an affidavit to the department demonstrating successful 12
completion of this clinical review. 13
(b) As long as the requirements in (a)(i), (ii), and (iii) of 14
this subsection are documented by the applicant, required education, 15
supervised instruction, and clinical review may occur or may have 16
occurred in another state or jurisdiction. 17
(2) A qualified provider must be one of the following:18
(a) A physician licensed under chapter 18.71 RCW; an osteopathic 19
physician licensed under chapter 18.57 RCW; a licensed naturopath 20
under chapter 18.36A RCW; a licensed acupuncture and Eastern medicine 21
practitioner under chapter 18.06 RCW; a licensed advanced registered 22
nurse practitioner under chapter 18.79 RCW; or any of these providers 23
licensed through an interstate compact or by another state;24
(b) An occupational or physical therapist credentialed to perform 25
intramuscular needling in any branch of the United States armed 26
forces; 27
(c) A licensed physical therapist who currently holds an 28
intramuscular needling endorsement; or 29
(d) A licensed physical therapist who meets the requirements of 30
the intramuscular needling endorsement. 31
(3) After receiving 100 hours of didactic instruction and 75 32
hours of in-person intramuscular needling instruction, an 33
occupational therapist seeking endorsement has up to 18 months to 34
complete a minimum of 150 treatment sessions for review.35
(4) An occupational therapist may not delegate intramuscular 36
needling and must remain in constant attendance of the patient for 37
the entirety of the procedure. 38
(5) An occupational therapist can apply for endorsement before 39
they have one year of clinical practice experience if they can meet 40
p. 4 HB 2184
the requirement of 100 hours of didactic instruction and 75 hours of 1
in-person intramuscular needling instruction in subsection (1)(a)(i) 2
and (ii) of this section through their prelicensure coursework and 3
has completed all other requirements set forth in this chapter.4
(6) If an occupational therapist is intending to perform 5
intramuscular needling on a patient who the occupational therapist 6
knows is being treated by an acupuncturist or acupuncture and Eastern 7
medicine practitioner for the same diagnosis, the occupational 8
therapist shall make reasonable efforts to coordinate patient care 9
with the acupuncturist or acupuncture and Eastern medicine 10
practitioner to prevent conflict or duplication of services.11
(7) All patients receiving intramuscular needling from an 12
occupational therapist must sign an informed consent form that 13
includes: 14
(a) The definition of intramuscular needling; 15
(b) A description of the risks of intramuscular needling;16
(c) A description of the benefits of intramuscular needling;17
(d) A description of the potential side effects of intramuscular 18
needling; and 19
(e) A statement clearly differentiating the procedure from the 20
practice of acupuncture. 21
(8) Intramuscular needling may not be administered as a stand-22
alone treatment within an occupational therapy care plan.23
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